What’s behind Mahoning County’s staggeringly high Black infant mortality rate?

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Though overall infant mortality rates are declining, there’s an ongoing racial disparity in Mahoning County.

There, the Black infant mortality rate was 15.6 deaths per 1,000 live births, compared to 5.9 for white infants between October 2019 and June 2021, said Michelle Fong, ODH spokesperson. Statewide, the Black infant mortality rate in that timeframe was 13 deaths per 1,000 live births compared to 5 for white infants, and 5.8 for children born to Hispanic mothers, according to Ohio Department of Health data.

The Ohio Department of Health tracks infant mortality rates on a quarterly basis in 12-month increments. Those figures — calculated as the number of infant deaths per 1,000 live births — account for fetal deaths, more commonly known as stillbirths; neonatal deaths, or infants lost within 28 days of their birth; post-neonatal deaths, or babies who survive their first month but not their first year; and sudden unexplained infant deaths, or SUID.

A CONGRESSIONAL CONCERN

While the disparities between infant mortality rates among African-Americans have been cause for concern for health care professionals for a number of years, Ohio has consistently had one of the highest Black infant mortality rates in the country.

It was enough to prompt U.S. Sen. Sherrod Brown of Cleveland, D-Ohio, to introduce the Sudden Unexpected Death Data Enhancement and Awareness Act to help scientists better identify the factors influencing this wide racial divide. It became law in 2014.

In 2019, then-presidential hopeful U.S. Rep. Tim Ryan of Howland, D-13th said, “An African-American baby born in Youngstown, Ohio, has a higher infant mortality rate than a baby born in Iran.”

A fact-check from The Washington Post affirmed Ryan’s statement was accurate, but noted it compared national statistics to local statistics. In 2019, Iran had an overall infant mortality rate of 12 deaths per 1,000 live births, according to United Nations data reported by The World Bank.

Whereas the International Monetary Fund in 2018 classified the U.S. as having an advanced economy, 60 of the 163 countries classified by the IMF that year as having emerging and developing economies, like Iran, had overall infant mortality rates lower than the 15.6 per 1,000 rate for Black infants in Mahoning County that year, according to The World Bank. Seven of those countries had a lower rate than the U.S., which was 6 deaths per 1,000 live births in 2019:

• Africa: Cabo Verde (13), Seychelles (12), Mauritius (14) and Tunisia (15);
• Asia: Armenia (11), Brunei Darussalam (10), China (7), Kazakhstan (9), Maldives (7), Mongolia (13), Sri Lanka (6) and Thailand (8);
• Caribbean islands: The Bahamas (11), Barbados (12), Grenada (15), Jamaica (12) and Saint Vincent and the Grenadines (13) Central America: Belize (11), Costa Rica (8), El Salvador (11), Honduras (15), Nicaragua (14) and Panama (13);
• Europe: Albania (9), Bosnia and Herzegovina (5), Bulgaria (6), Croatia (4), Georgia (9), Hungary (3), Moldova (12), Montenegro (2), North Macedonia (5), Poland (4) Romania (6), Russia (5) and Ukraine (7);
• The Middle East: Bahrain (6), Iran (12); Jordan (13), Kuwait (7), Lebanon (6), Libya (10), Oman (10), Qatar (6), Saudi Arabia (6), Turkey (9) and United Arab Emirates (6);
• North America: Mexico (12); Oceania: Samoa (13) and Tonga (14);
• South America: Argentina (8), Brazil (12), Chile (6), Colombia (12), Ecuador (12), Peru (10) and Uruguay (6);
• West Indies islands: Antigua and Barbuda (6) and Saint Kitts and Nevis (13).

A LEAD LINK?

Youngstown Mayor Jamael Tito Brown during his re-election campaign last year highlighted the Black infant mortality rate as a priority. He suggested there’s a link between the child mortality rate in African-American neighborhoods and lead exposure.

According to ODH child lead exposure data, 0.9% of the nearly 2,700 Mahoning County children screened for lead in 2012 had blood-lead levels of at least 10 micrograms per deciliter — which was considered “elevated.” It was the 16th highest rate among Ohio’s 88 counties.

Harrison and Cuyahoga counties had the highest rates statewide in 2012, at 3.55% and 3.21% respectively. In Columbiana County, 1.14% of all children screened that year had elevated blood-lead levels; in Trumbull, that rate was 0.51%.

There is no “safe” level of lead exposure, according to ODH. Lead can harm adults’ reproductive health and also irreversibly harm a developing child’s nervous system, cause permanent brain damage that can impact behavior or learning and, in some cases, even lead to death.

In 2012, the U.S. Centers for Disease Control and Prevention dropped its elevated blood-lead level threshold from 10 micrograms to 5 micrograms, and again last year, to 3.5 micrograms.

ODH in 2012 predicted more than 1 in 3 children in Youngstown’s Warren neighborhood would have a blood-lead level of at least 5 micrograms per deciliter — nearly 38%, which was the highest probability in the county, according to ODH.The census tract identified in the study spans from the intersection of West Warren and Glenwood avenues at its northwest corner to the intersection of Youngstown-Salem Road and State Route 62 in the southeast.

Though lead-based paint found in older homes is thought to be the main source of lead exposure, many leaden water service pipes still run underground today. An independent study by the Natural Resources Defense Council found Ohio uses the second-highest number of lead lines nationwide, with an estimated 650,000 pipes in use across the state.

ODH: SOCIAL FACTORS PLAY A BIGGER ROLE

A recent ODH study which addresses the state’s health priorities suggests Black infant mortality is more influenced by a compounded layer of social and environmental factors. The data showed the biggest factor influencing health is the social, economic and physical environment. This can include housing, community conditions, education, transportation, education, air quality and underlying social and systemic inequity.

A 2017 report from Health Policy Institute of Ohio recommended a focus on social determinants as a key strategy to decreasing African-American infant mortality rates, including poverty, racism, violence, discrimination, trauma and toxic stress.

Johsulen Harrison, 32, a Youngstown mother of four, cited cultural disconnection as a barrier to proper health care treatment for African-American mothers.

“Having a baby in Mahoning County makes me think of the lack of African-American doctors available. I think that matters because a Black doctor is going to understand more. I really do think that compared to Black women, white women get treated better during pregnancy,” she said.

Harrison said throughout her pregnancy she expressed concerns about her health that were initially ignored by her doctors.

“I’ve been sick my whole pregnancy [including] not being able to keep anything down and feeling like I was on my deathbed,” she said. “The doctor said that it is something that I would have to get used to. That was hurtful when there is stuff that is out there that you can give me.”

PUBLIC HEALTH ADAPTING

Youngstown City Health Commissioner Erin Bishop said the city health department has been adjusting to address social components that contribute to infant mortality and empowering Black mothers to make health care more accessible.

“Our focus previously was on women and their social support system. We did focus on the mother’s health coming into the pregnancy. We’re still going to focus on that and we’ve added another layer,” Bishop said.

To provide additional support and resources for Black mothers in the county, Mahoning County Public Health has joined forces across the state to implement the Vibrant Valley Health Equity Plan along with its existing MY Baby’s 1st program, according to Michelle Edison, the agency’s director of health equity strategies and initiatives.

Edison said the Vibrant Valley Health Equity Plan is a countywide strategic plan across private and public institutions to carry out policies and procedures that address inequality for residents across social and economic backgrounds.

The MY Baby’s 1st program works alongside clinical, social and behavioral health providers to address the risk factors that prevent Black mothers from getting the type of needed to help close the Black infant mortality gap.

Mahoning Matters staff contributed to this report.

This story was originally published January 18, 2022 4:00 AM.